Applying Skin Traction and Caring for a Patient in Skin Traction

Goal: The traction is maintained with the appropriate counterbalance and the patient is free from complications of immobility.

1. Review the medical record and the nursing plan of care to determine the type of traction being used and care for the affected body part.

2. Perform hand hygiene. Put on PPE, as indicated.

3. Identify the patient. Explain the procedure to the patient, emphasizing the importance of maintaining counterbalance, alignment, and position.

4. Perform a pain assessment and assess for muscle spasm. Administer prescribed medications in sufficient time to allow for the full effect of the analgesic and/or muscle relaxant.

5. Close curtains around bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height.

Applying Skin Traction
6. Ensure the traction apparatus is attached securely to the bed. Assess the traction setup.

7. Check that the ropes move freely through the pulleys. Check that all knots are tight and are positioned away from the pulleys. Pulleys should be free from the linens.

8. Place the patient in a supine position with the foot of the bed elevated slightly. The patient’s head should be near the head of the bed and in alignment.

9. Cleanse the affected area. Place the elastic stocking on the affected limb, as appropriate.

10. Place the traction boot over the patient’s leg. Be sure the patient’s heel is in the heel of the boot. Secure the boot with the straps.

11. Attach the traction cord to the footplate of the boot. Pass the rope over the pulley fastened at the end of the bed. Attach the weight to the hook on the rope, usually 5 to 10 pounds for an adult. Gently let go of the weight. The weight should hang freely, not touching the bed or the floor.

12. Check the patient’s alignment with the traction.

13. Check the boot for placement and alignment. Make sure the line of pull is parallel to the bed and not angled downward.

14. Place the bed in the lowest position that still allows the weight to hang freely.

15. Remove PPE, if used. Perform hand hygiene.

Caring for a Patient With Skin Traction:
16. Perform a skin-traction assessment per facility policy. This assessment includes checking the traction equipment, examining the affected body part, maintaining proper body alignment, and performing skin and neurovascular assessments.

17. Remove the straps every 4 hours per the physician’s order or facility policy. Check bony prominences for skin breakdown, abrasions, and pressure areas. Remove the boot, per physician’s order or facility policy, every 8 hours. Put on gloves and wash, rinse, and thoroughly dry the skin.

18. Assess the extremity distal to the traction for edema, and assess peripheral pulses. Assess the temperature, color, and capillary refill, and compare with the unaffected limb. Check for pain, inability to move body parts distal to the traction, pallor, and abnormal sensations. Assess for indicators of deep-vein thrombosis, including calf tenderness, and swelling.

19. Replace the traction and remove gloves and dispose of them appropriately.

20. Check the boot for placement and alignment. Make sure the line of pull is parallel to the bed and not angled downward.

21. Ensure the patient is positioned in the center of the bed, with the affected leg aligned with the trunk of the patient’s body.

22. Examine the weights and pulley system. Weights should hang freely, off the floor and bed. Knots should be secure. Ropes should move freely through the pulleys. The pulleys should not be constrained by knots.

23. Perform range-of-motion exercises on all unaffected joint areas, unless contraindicated. Encourage the patient to cough and deep breathe every 2 hours.

24. Raise the side rails. Place the bed in the lowest position that still allows the weight to hang freely.

25. Remove PPE, if used. Perform hand hygiene.